There is significant variation in the provision and access to many physiology diagnostics and services across the eight clinical specialties (audiology, cardiac, gastrointestinal, respiratory and sleep, neurophysiology, vascular, vision,
urodynamic). This is despite many of these diagnostic tests being an integral part of NICE clinical guidelines and to improving outcomes.
The provision of services outside of the traditional working week is very limited apart from in certain areas and for a small number of tests. Most models of seven day service provision are predominantly to provide ‘out of hours’, and Saturday and Sunday cover via an ‘on call’ service, rather than a shift based model to provide full seven day provision.
ASTUTE: Acute Stroke Telemedicine: Utility Training and Evaluation
Implementing Telemedicine in Acute Stroke and the development of a Standardised Telemedicine Tookit
Lancashire Teaching Hsopitals NHS Foundation Trust
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
National projects: making a difference for your heart failure patientsNHS Improvement
National projects: Making a difference for your heart failure patients
In March 2010, NHS Improvement invited organisations to work in partnership on projects dedicated to improving the heart failure pathway, up to and including end of life projects. Projects were submitted from acute trusts, PCTs and cardiac and stroke networks and some with involvement of palliative care services. This publication provides a flavour of the work that was undertaken, and celebrates the project teams' hard work and achievement.
(Published September 2011)
The Indraprastha Apollo Hospital in Delhi is the largest corporate hospital in India and fourth largest in the world. It has 652 beds including 138 ICU beds across 14 operation theaters within its 675,000 square foot built up area. The hospital aims to reduce the complexity of such a large institutional space. It houses departments for general OPD services, emergency, medicine, surgery, dentistry, obstetrics/gynecology and more. The inpatient wards are placed above the clinical zones and utilize colors/patterns to feel more like home. The large atrium in the outpatient department provides light and a street-like atmosphere. Medical facilities prioritize flexibility with engineering plants between wards and clinical areas below.
Location and layout of hospital, need of hospital to community,planning,factors and data required in planning,fundamentals and objectives,principles,different stages,equipment planning,icu design and layout,quality quantity and temperature and noise control in hospital,conclusion
The document discusses factors that contribute to successful change agents or "boat rockers". It identifies four key things: 1) having a strong sense of self-efficacy or belief in one's ability to create change; 2) being able to join forces with others to take action; 3) being able to achieve small wins which build momentum; and 4) viewing obstacles as challenges to overcome rather than barriers. Building self-efficacy involves tactics like starting with small, achievable changes and reframing failures as learning opportunities. Social support and learning from exemplars are also discussed.
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
ASTUTE: Acute Stroke Telemedicine: Utility Training and Evaluation
Implementing Telemedicine in Acute Stroke and the development of a Standardised Telemedicine Tookit
Lancashire Teaching Hsopitals NHS Foundation Trust
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
National projects: making a difference for your heart failure patientsNHS Improvement
National projects: Making a difference for your heart failure patients
In March 2010, NHS Improvement invited organisations to work in partnership on projects dedicated to improving the heart failure pathway, up to and including end of life projects. Projects were submitted from acute trusts, PCTs and cardiac and stroke networks and some with involvement of palliative care services. This publication provides a flavour of the work that was undertaken, and celebrates the project teams' hard work and achievement.
(Published September 2011)
The Indraprastha Apollo Hospital in Delhi is the largest corporate hospital in India and fourth largest in the world. It has 652 beds including 138 ICU beds across 14 operation theaters within its 675,000 square foot built up area. The hospital aims to reduce the complexity of such a large institutional space. It houses departments for general OPD services, emergency, medicine, surgery, dentistry, obstetrics/gynecology and more. The inpatient wards are placed above the clinical zones and utilize colors/patterns to feel more like home. The large atrium in the outpatient department provides light and a street-like atmosphere. Medical facilities prioritize flexibility with engineering plants between wards and clinical areas below.
Location and layout of hospital, need of hospital to community,planning,factors and data required in planning,fundamentals and objectives,principles,different stages,equipment planning,icu design and layout,quality quantity and temperature and noise control in hospital,conclusion
The document discusses factors that contribute to successful change agents or "boat rockers". It identifies four key things: 1) having a strong sense of self-efficacy or belief in one's ability to create change; 2) being able to join forces with others to take action; 3) being able to achieve small wins which build momentum; and 4) viewing obstacles as challenges to overcome rather than barriers. Building self-efficacy involves tactics like starting with small, achievable changes and reframing failures as learning opportunities. Social support and learning from exemplars are also discussed.
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
The document discusses how change is happening more rapidly, with projects now lasting 30-60 days rather than years. It also discusses how power is shifting away from hierarchies and centralized control to networks and relationships. Leaders are needed who can operate from the "edge" and empower others through open relationships rather than closed transactions. Rebels are needed who can disrupt and challenge the status quo in a responsible way to drive innovation and new ways of thinking.
The greatest pleasure in life is doing what people say you cannot do. Anonymo...NHS Improving Quality
The document discusses issues with diagnosing and managing patients with respiratory conditions like COPD, asthma, and heart failure in primary care settings, noting evidence of high rates of misdiagnosis, underdiagnosis of comorbidities, and fragmented services. It proposes a new enhanced care/case management service called the "Breathlessness Service" to provide more coordinated care to improve outcomes for these patients experiencing breathlessness. Case studies are presented showing how the new service achieved better diagnoses and management of patients' conditions.
Presentation slides Frailty: building understanding, empathy and the skills t...NHS Improving Quality
Frailty: building understanding, empathy and the skills to support self-care
Guest speaker:Dr Dawn Moody, Director - Fusion48
An opportunity to learn about some innovative approaches to making the health and care workforce 'Fit for Frailty'* (*British Geriatrics Society 2015).
Learning outcomes:
To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty
To hear how Virtual Reality is being used to build empathy for older people living with frailty
To learn about the impact of a county-wide, multi-agency, multi-professional training an toolkit for care professionals working with older people
Resources:www.fusion48.net
Self-management in the community and on the Internet - Presentation 22nd Marc...NHS Improving Quality
LTC Lunch & Learn webinar:- 22nd March 2016
Presenter:- Pete Moore, Educator, Author & Pain Toolkit Trainer
As pain is the most daily health problem reported to a GP-
Developing a national pain strategy- reviews from around the world
Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient C...NHS Improving Quality
Speaker slides from the national conference, 'Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life', 17 March 2016
Fire service as an asset: providing telecare support in the community Webinar...NHS Improving Quality
Guest speaker: Steve Vincent - West Midlands Fire Service & Simon Brake from Coventry Council
Hosted by: Bev Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:-
To better understand the role that the Fire and Rescue service can provide as a community asset to support health needs Enhancing the quality of life for people by supporting them to stay in their own home, even in a crisis
An overview of the work carried out by NHS England and NHS Improving Quality's Long Term Conditions Sustainable Improvement Team. It puts the case for why person-centred care has to be at the heart of healthcare.
Commissioning Integrated models of care
Kent LTC Year of Care Commissioning Early Implementer Site
Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's
Integrated data to support service redesign decision making 19 01 2016 finalNHS Improving Quality
Integrated data to support service redesign decision making
Leeds LTC Year of Care Commissioning Early Implementer Site
Tricia Cable, Year of Care Lead
Alison Phiri, Business Intelligence Manager
Mohini Chauhan, Year of Care Commissioning Manager
Slides from a lunch and learn webinar hosted by NHS England's Long Term Conditions Team, on the topic of health coaching by lay professionals.
The speakers and Anya de Longh and Jim Phillips.
This document announces a networking event hosted by the Sustainable Improvement Team for long term conditions in the Midlands and East of England on November 3rd, 2015 in Leicester. The event aimed to connect professionals working with long term conditions to discuss improvement initiatives. It used the hashtags #LTCImp and #A4PCC to promote discussion of long term condition improvement and accountable care organizations on social media.
The document discusses how change is happening more rapidly, with projects now lasting 30-60 days rather than years. It also discusses how power is shifting away from hierarchies and centralized control to networks and relationships. Leaders are needed who can operate from the "edge" and empower others through open relationships rather than closed transactions. Rebels are needed who can disrupt and challenge the status quo in a responsible way to drive innovation and new ways of thinking.
The greatest pleasure in life is doing what people say you cannot do. Anonymo...NHS Improving Quality
The document discusses issues with diagnosing and managing patients with respiratory conditions like COPD, asthma, and heart failure in primary care settings, noting evidence of high rates of misdiagnosis, underdiagnosis of comorbidities, and fragmented services. It proposes a new enhanced care/case management service called the "Breathlessness Service" to provide more coordinated care to improve outcomes for these patients experiencing breathlessness. Case studies are presented showing how the new service achieved better diagnoses and management of patients' conditions.
Presentation slides Frailty: building understanding, empathy and the skills t...NHS Improving Quality
Frailty: building understanding, empathy and the skills to support self-care
Guest speaker:Dr Dawn Moody, Director - Fusion48
An opportunity to learn about some innovative approaches to making the health and care workforce 'Fit for Frailty'* (*British Geriatrics Society 2015).
Learning outcomes:
To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty
To hear how Virtual Reality is being used to build empathy for older people living with frailty
To learn about the impact of a county-wide, multi-agency, multi-professional training an toolkit for care professionals working with older people
Resources:www.fusion48.net
Self-management in the community and on the Internet - Presentation 22nd Marc...NHS Improving Quality
LTC Lunch & Learn webinar:- 22nd March 2016
Presenter:- Pete Moore, Educator, Author & Pain Toolkit Trainer
As pain is the most daily health problem reported to a GP-
Developing a national pain strategy- reviews from around the world
Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient C...NHS Improving Quality
Speaker slides from the national conference, 'Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life', 17 March 2016
Fire service as an asset: providing telecare support in the community Webinar...NHS Improving Quality
Guest speaker: Steve Vincent - West Midlands Fire Service & Simon Brake from Coventry Council
Hosted by: Bev Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:-
To better understand the role that the Fire and Rescue service can provide as a community asset to support health needs Enhancing the quality of life for people by supporting them to stay in their own home, even in a crisis
An overview of the work carried out by NHS England and NHS Improving Quality's Long Term Conditions Sustainable Improvement Team. It puts the case for why person-centred care has to be at the heart of healthcare.
Commissioning Integrated models of care
Kent LTC Year of Care Commissioning Early Implementer Site
Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's
Integrated data to support service redesign decision making 19 01 2016 finalNHS Improving Quality
Integrated data to support service redesign decision making
Leeds LTC Year of Care Commissioning Early Implementer Site
Tricia Cable, Year of Care Lead
Alison Phiri, Business Intelligence Manager
Mohini Chauhan, Year of Care Commissioning Manager
Slides from a lunch and learn webinar hosted by NHS England's Long Term Conditions Team, on the topic of health coaching by lay professionals.
The speakers and Anya de Longh and Jim Phillips.
This document announces a networking event hosted by the Sustainable Improvement Team for long term conditions in the Midlands and East of England on November 3rd, 2015 in Leicester. The event aimed to connect professionals working with long term conditions to discuss improvement initiatives. It used the hashtags #LTCImp and #A4PCC to promote discussion of long term condition improvement and accountable care organizations on social media.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
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Challenges and improvements in diagnostic services across seven days
Interventional radiology
Foreword
Across the country, hospitals and primary and community care organisations are working together to
look at ways of delivering safe and effective care over seven days a week. This helps address the link
between poorer outcomes for patients and the reduced levels of service provision at the weekend.
Interventional radiology (IR) intervention can prevent death from sepsis by draining
abscesses, prevent rupture of aneurysms by a variety of techniques and save limbs
by reperfusion techniques. IR embolisation procedures can also be life saving for
patients with post partum bleeding, haemorrhage after trauma and gastrointestinal
bleeding.
Healthcare Scientist survey of seven day service provision
NHS
NHS Improvement
NHS Improvement
Equality for all
NHS Improving Quality conducted an online survey of
healthcare scientist service provision across England in 2013.
365 healthcare scientists completed the survey. Key findings
included:
Have you asked service users if your model
of provision successfully meets their needs?
Delivering safe care - seven days a week
Diagnostic and scientific services underpin all models of care irrespective of settings and most clinical pathways.
Nationally, the seven day service forum, led by Sir Bruce Keogh, Medical Director for NHS England, has set out a
plan to drive seven day services across England in the next three years1, as part of a transformational
improvement programme. For this plan to be successful diagnostic and scientific services must be at the centre
of service transformation. There are therefore huge opportunities for these services to contribute to delivery of
this plan and to improve patient experience and outcomes.
Previous publications by NHS Improving Quality, Equality for all: delivering safe care seven days a week,
and more recently, NHS Services open seven days a week: every day counts, provide practical examples of how
diagnostic and scientific services have started to design and deliver services to give patients care and treatment
seven days a week.
This new publication summarises service improvement achievements and potential challenges. Whilst significant
progress has been made we need to strive to find new and innovative solutions that are both clinically and
financially sustainable to change delivery of diagnostic and scientific services to meet the needs of service users.
A baseline survey of acute trusts (NHS Improvement, 2011/12), identified variation
in IR service provision across England. Interventional radiology departments, were
asked to self-assess their service provision based on whether a formal on-call
consultant rota and agreed formal pathway of care were in place. Improvement
work resulted in an increase in the extent of 24/7 provision across England.
CANCER
DIAGNOSTICS
HEART
LUNG
STROKE
Case studies of how organisations have overcome challenges in ‘Towards best
practice in Interventional Radiology’ NHS Improvement (June 2012) and ‘Equity for
All’ can be viewed here at: www.nhsiq.nhs.uk/8796.aspx
IR interventions are usually, but not exclusively, performed as an emergency/urgent
intervention. Nephrostomy is a core service to which patients require access to on
a seven days basis. A map of variation in nephrostomy out of hours and in hours services can be seen at:
www.nhsiq.nhs.uk/8796.aspx
Endoscopy services
Professor Erika Denton FRCP, FRCR
National Clinical Director for Diagnostics, NHS England
“Average GI bleeding mortality rate is reduced by 10% by
having access to 24/7 endoscopy, interventional radiology
and surgery working together as a multidisciplinary team.”
Professor Sue Hill OBE
Chief Scientific Officer
1
NHS Services, Seven Days a Week Forum. Summary of initial findings. NHS England, December 2013.
www.england.nhs.uk/2013/12/15/sir-bruce-keogh-7ds
Erika Denton, National Clinical Director for Diagnostics
Radiology services
NHS
Improving Quality
Since the publication of Implementing Seven Day Working in Imaging
Departments: Good Practice Guidance (DH 2011), and in response to changes
in the care pathways for specific diseases, radiology departments have
developed local strategies to deliver timely diagnostic imaging to patients. For
example, in acute care, patients with suspected acute stroke now receive an
immediate clinical assessment, including a brain scan within 60 minutes of
request and clinical interpretation which determines the treatment pathway.
Rapid access to scanning facilities in trauma centres and acute emergency
departments has significantly improved.
NHS services - open seven
days a week:
The development of Heart Attack Centres has also changed working practices
for radiology departments, who have developed on call radiography services to
cover the cardiac catheter laboratories for emergency primary percutaneous
intervention (PPCI) across England.
Whilst significant progress has been made in these areas, and most radiology
services deliver some routine outpatient services for part of the weekend, there are only a limited number of service
models offering general radiology, CT, MRI and ultrasound on site seven days a week. More information is available at:
www.nhsiq.nhs.uk/8813.aspx
There is wide variation in the access and provision of out of hours service for
patients requiring emergency endoscopy for upper gastrointestinal bleeding. The
NICE guidance for managing patients presenting with Acute Upper Gastrointestinal
Bleeding (AUGIB) was published in 2012. This guidance specifies that there should
be access to endoscopy for all unstable patients with severe bleeding immediately
after resuscitation and for all other patients within 24 hours of admission. In
addition, larger units managing more than 330 cases a year, should provide daily
endoscopy lists.
A recent British Society for Gastroenterology survey of 153 endoscopy units, identified that 60% of units achieved this
core service provision or had a formal network pathway to an agreed recipient Trust. Since March 2013, the British
Society for Gastroenterology (BSG) working with NHS Improving Quality have been gathering evidence on models of
24/7 out of hours service provision that could be developed across England.
With unprecedented increasing demand on elective endoscopy services due, in part, to the expansion of the bowel
cancer screening programme, it has been essential for clinical teams to ensure that their overall service is as efficient
and productive as possible.
NHS Improving Quality has undertaken two pieces of work on efficient use of resources across the week: both are
available at: www.nhsiq.nhs.uk/7923.aspx.
The ‘Productive Endoscopy Unit’ toolkit, developed in conjunction with professional bodies, will support all endoscopy
services to work towards a seven day service, increase productivity, improve safety and support earlier diagnosis.
• Majority of staff believe they should offer services seven
days a week
• Less than 50% of departments consult with service users
regarding the need for services seven day a week
• 50% of services had expanded services across seven days,
using predominantly on-call systems for specific diagnostic
tests rather than whole department service provision
• Key drivers for expanding service delivery included urgent and
emergency care demand, elective work demand and to
manage waiting times
• Pathology – 17% of organisations surveyed offered a full
spectrum of service over 24/7
• Radiology - limited number of service models delivering on
site general radiology, CT and MRI seven days a week
• Cardiac physiology – minimal evidence of ‘whole department’
provision of seven day service.
46.1%
53.9%
YES
NO
Pathology service provision
Pathology services underpin over 80% of all diagnoses in all care
settings and are an integral part of most clinical pathways and
clinical guidelines. There is however, significant variation in
provision of pathology services across the week in terms of
location, specialism and test availability.
Most pathology laboratories provide routine services such as
biochemistry and haematology over a seven day period, but
others such as histopathology operate a traditional five day
working week in most organisations.
The recent Healthcare Science survey (2013) identified however
that only 17% of organisations surveyed offer a full spectrum of
service over 24/7. There is a risk to sustainability to all services
because one third were using an on call service. Half were
providing it on a shift basis predominantly in haematology,
biochemistry and microbiology, mainly to meet clinical demand
and urgent and emergency care. The main barriers reported to
delivering seven day services were financial restrictions and staff
rota preferences.
Pathology services, drawing upon evidence from both within England via NHS Improving Quality, and the UK, as well
other countries around the world, should use this opportunity to develop robust, affordable and sustainable models of
seven day service provision across all specialisms to improve patient outcomes and patient experience.